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Gomez-Hernandez M, Gallego-Izquierdo T, Martinez-Merinero P, et al. Benefits of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia: a randomized controlled trial. Clin Rehabil. 2020 Feb;34(2):242-251. doi: 10.1177/0269215519893107. Epub 2019 Dec 18. (Original study)
Abstract

OBJECTIVE: To investigate the effects of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia.

DESIGN: Randomized controlled trial.

SUBJECTS: Sixty-four female patients who were diagnosed with fibromyalgia syndrome based on the American College of Rheumatology criteria were recruited (mean age: 54.27 ± 6.94 years).

INTERVENTIONS: The control group (n = 32) underwent supervised moderate-intensity cycling (50%-70% of the age-predicted maximum heart rate) three times per week for 12 weeks. The experimental group (n = 32) underwent the same exercise programme plus a stretching programme once per week for 12 weeks.

MAIN MEASURES: The main measures of this study were sleep quality assessed by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, the impact of fibromyalgia on quality of life assessed by the Fibromyalgia Impact Questionnaire, and pain perception assessed by the visual analogue scale at baseline, after 4 weeks, and after 12 weeks.

RESULTS: The experimental group experienced significant improvements at 4-week measure compared with control group: Pittsburgh Sleep Quality Index (P < 0.001); Epworth Sleepiness Scale (P = 0.002); Fibromyalgia Impact Questionnaire (0.93 ± 7.39, P < 0.001); and visual analogue scale (0.52 ± 0.05, P < 0.001). Also at 12-week measure, experimental group experienced significant improvements compared with control group: Pittsburgh Sleep Quality Index (P < 0.001), Epworth Sleepiness Scale (P < 0.001); Fibromyalgia Impact Questionnaire (1.15 ± 9.11, P < 0.001); and visual analogue scale (0.81 ± 0.62, P < 0.001).

CONCLUSION: Adding stretching to a moderate-intensity aerobic exercise programme increased sleep quality, decreased the impact of fibromyalgia on the quality of life, and reduced pain compared with just a moderate-intensity aerobic exercise programme in our sample of women with fibromyalgia.

Ratings
Discipline Area Score
Psychologist 6 / 7
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

"Double-blind"?? There are a few small translation errors. There is more attention to sleep-related variables than the average fibromyalgia study.

Physician rater

As a rheumatologist, I find the results from this controlled study are relevant to clinical practice. The article suggests that adding a brief stretching program once a week to moderate-intensity aerobic exercise can be helpful in improving the quality of sleep and reducing the impact of fibromyalgia on the quality of life in women with fibromyalgia.

Physician rater

I would have like to have seen more about the clinical significance of these changes (rather than low p values showing statistical significance).

Physician rater

The discussions of the result are not sufficient. The reason why the stretching is effective in women with fibromyalsia is not clear.

Psychologist rater

Good data in an area that needs more treatment-relevant research findings. The study appears to have been carefully planned and executed and resulted in clinically useful findings.

Psychologist rater

This is an interesting study that contributes to correct several misconceptions about the benefits of stretching on fibromyalgia. I look forward to both longer follow-ups that allow conclusions about the maintenance of the treatment and a new design with the same amount of intervention (and attention) in the experimental and the control groups.

Rehab Clinician (OT/PT) rater

As the authors point out, the stretching group did considerably more exercise than the aerobic exercise group (more than twice as much time). The lack of a control group also limits the findings. Nonetheless, a positive effect on sleep quality is useful to know.

Rehab Clinician (OT/PT) rater

This is an interesting article, as there is limited evidence regarding the role of stretching exercise in patients with chronic pain. It would be interesting to compare to a more generalised control group doing other exercises to see what the difference might be.
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